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Sunday, October 25, 2020
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A new approach to improving life expectancy and quality of life in dogs with DM

The prognosis for canine patients with degenerative myelopathy (DM) is often grim. However, recent findings demonstrate that individual exercise programs combined with photobiomodulation can improve quality of life and longevity.

The mention or diagnosis of degenerative myelopathy (DM) often takes the wind out of many practitioners’ sails. Historically, dogs diagnosed with DM – formally or through process of elimination – do not have an optimistic future. A typical course of action involves palliative care, preparation for assistive devices, and euthanasia planning. Many owners will quickly peruse the internet and find information on ‘cures’ or suggestions – though many of these findings offer little to no hope.

New studies offer promising results

Despite the prognosis that typically accompanies a DM diagnosis, there are many recent advances in how we care for dogs with this disease. For instance, a study by Kathmann et al. demonstrated an increase in life expectancy with the introduction of an intensive therapeutic exercise program.i Preliminary research has demonstrated an even longer improvement in life expectancy and quality of life with the introduction of photobiomodulation (PBM) in conjunction with an individual therapeutic exercise program.

The most recent study examined the impact of intensive PBM and an exercise program compared to an exercise program with less intense PBM. It included twice weekly in-clinic rehabilitation therapy, photobiomodulation, range-of-motion exercises and stretching, core exercises, and an at-home exercise program. In addition, the owners were invited to maintain a log of the dog’s daily activities and function. Supportive care recommendations were made and encouraged as the dog needed them. They included the use of harnesses, walking supports, protective boots and socks.

Applying the findings

I encourage owners to come in twice a week with their dog because the prospect of additional clinical visits favors the dog’s potential outcome. Flexible clinic hours and the ability to day board assists in seeing the dogs twice a week.

PBM

I begin the treatment with PBM (before exercise), but if the schedule does not permit, we can perform the PBM last during the in-house treatment session. I prefer a Class IV laser unit to offer delivery of sufficient energy in an efficient timeframe and sufficient irradiance to achieve dosing deep to the spinal cord. The treatment area includes the thoracic region from T6 to T13, and then the lumbar region. My preference is a contact method so the dog benefits from the massage and pressure action of the unit and minimizing reflection of light off the skin. In the study demonstrating the improvement, a 980nm wavelength was used, emitting  6 to 12 Watts (increased for larger dogs. i.e., German Shepherds) and an energy density of 14 to 21 j/cm2. A continuously  moving grid is utilized at a speed of 1 to 3 inches per second. The total treatment time may be between 25-30 minutes – lengthy, but incredibly beneficial.

Stretching

The dog should be comfortable and, if possible, be encouraged to stretch throughout the session. Dogs with DM need a great deal of hip extension stretching due to the positioning of their hips and lumbar spine. Shoulder extension is another area that needs to be addressed secondary to the increase in weightbearing on the forelimb complex.

Exercise

Core exercises are a principal component for successful rehabilitation. Begin with standing exercises and gentle weight shifting. The weight shifting should be firm enough to encourage a weight shift, but not so firm as to throw the dog off balance. Ideally, I like to see a slow weight shift and weight bearing on the limbs. I suggest working medial to lateral, cranial to caudal, and then diagonally. This should be performed until fatigue, with a focus on quality not quantity.

One dog may be able to perform this for a total of one minute, while others may be able to perform it for up to five minutes. The progression from here will be on safe and phthalate-free surfaces. This will add increased balance, proprioception, body awareness and core strength. Since DM will result in continued loss of the postural muscles and respiratory muscles, it is imperative to prepare the dog. The added and continued strength of the core musculature may result in  decreased pulmonary complications, and improved strength throughout the body whether they are ambulatory or in any assistive device.

Additional therapeutic exercises such as negotiating over unstable surfaces, walking over cavalettis, and modified walking are also recommended. An underwater treadmill will allow an increase in endurance, an improvement in cardiac and pulmonary strength, and overall muscle strength. The water height may be adjusted to increase or decrease weightbearing, and the properties of water will assist with buoyancy. The action of walking in water will also allow for active hip extension. I prefer underwater treadmill walking over swimming since it activates more of the shoulder and hip extensors and remains a weight-bearing exercise.

Setting realistic goals and expectations

The establishment of short- and long-term goals will be important to increase the intensity of exercises. With PBM, range-of-motion, core exercises, therapeutic exercises, the underwater treadmill and a home exercise program, it is not uncommon to see an improvement initially, a plateau and a gradual decline. The short-term goals should be adjusted every two to three weeks.

While there is no ‘secret’ formula to maintain a full life expectancy for dogs with DM, there is hope in  prolonging the length and quality of life. The combination of intense photobiomodulation, active exercises, underwater treadmill, range-of-motion, and appropriate nutrition can improve the longevity and quality of life with dogs with DM.

iKathmann I, Cizinauskas S, Doherr MG, Steffen F, Jaggy A.  Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy. J Vet Intern Med. 2006;20(4):927–32.

Helping your clients manage BAS in their dogs

Gaining a better understanding of Brachycephalic Airway Syndrome (BAS) in dogs is key to advising your clients on best management practices.

The selective breeding that has given brachycephalic breeds such as Chihuahuas, Pugs and French Bulldogs their distinctively flat faces has concurrently led to a compression of their upper respiratory anatomy. The extent of these anatomical differences and the degree to which they cause airway obstruction is variable between breeds and individuals. Here, we’ll look at how to identify Brachycephalic Airway Syndrome (BAS) and the recommendations for management.

Brachycephalic Airway Syndrome

BAS is defined as airway obstruction caused by primary characteristics such as stenotic nares, soft palate elongation and hyperplasia, and tracheal hypoplasia. The resultant air turbulence in the upper respiratory tract can lead to secondary abnormalities, including everted laryngeal saccules and laryngeal or tracheal collapse.1,2

Patients often present with a combination of stridor, inspiratory dyspnea and exercise intolerance; in severe cases, heat stroke and episodes of cyanosis or syncope may occur, and the airway obstruction may be life-threatening.

Diagnosing BAS is based on an assessment of the dog’s respiratory anatomy in relation to published criteria in order to identify abnormalities; as such, the diagnosis is made by laryngoscopy and/or tracheoscopy. Surgical techniques have been developed to address several of the abnormalities associated with BAS, with the aim of reducing upper airway obstruction; these include rhinoplasty, soft palate resection and removal of everted laryngeal saccules.3 There is evidence that early intervention leads to a better prognosis, since secondary laryngeal changes can be present in puppies as young as six months old.4 However, some abnormalities such as tracheal hypoplasia cannot be treated surgically, and correct management will continue to be important in these BAS patients.

Management recommendations

1. Safe exercise

It is important to provide advice to clients for safe exercise management in dogs suffering from BAS. Overexertion and overheating can precipitate breathing problems; conversely, obesity arising from lack of exercise exacerbates airway obstruction. These dogs should not undertake strenuous outdoor exercise in hot or humid weather; owners should be encouraged to provide their dogs with alternative opportunities for moderate exercise in cool air-conditioned environments.4,5

2. Use of a harness

A standard collar and lead can put intense pressure on the trachea and exacerbate symptoms of BAS, sometimes triggering tracheal collapse. A low-front harness is recommended for these breeds, even if they are not showing symptoms of BAS.6

3. Hyperthermia awareness

Owners of brachycephalic breeds need to understand that their dogs may not be able to cool down by panting as effectively as other breeds do, so they should take preventive measures to protect their dogs from overheating. Advice includes avoiding outdoor activity in hot weather, checking that pavement or asphalt is not too hot for walking barefoot, and maintaining a cool temperature within the home. Owners should also be made aware of the signs of heat stroke. and the importance of acting quickly if they notice these symptoms in their dogs.

The degree of airway obstruction experienced by brachycephalic dogs varies widely, and not all meet the criteria for a diagnosis of BAS. As clinicians, therefore, it is important that we educate our clients on the early signs of BAS and make timely surgical and management recommendations.

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1“Brachycephalic Airway Syndrome” from PetMD, petmd.com/dog/conditions/respiratory/c_multi_brachycephalic_airway_syndrome.

2Lodato DL, Hedlund CS (2012). “Brachycephalic airway syndrome: pathophysiology and diagnosis”. Compend Contin Educ Vet, 34 7, E3.

3Lodato DL, Hedlund CS. (2012). “Brachycephalic airway syndrome: management”. Compend Contin Educ Vet, 34 8, E4.

4Pink JJ, et al. “Laryngeal collapse in seven brachycephalic puppies”. J. Small Animal Practice 47.3 (2006): 131-135; and “Brachycephalic-friendly exercise ideas” from American Kennel Club, akc.org/expert-advice/dog-breeds/sports-snouts-and-extreme-weather-workout-safety-for-flat-faced-dogs/

5“Harnesses for brachycephalic breeds from WileyPup”. wileypup.com/best-harness-for-french-bulldog/

How moist wound healing can benefit you and your patients

Wound scabs are an evolutionary marvel, but are they the most efficient way to heal? Discover how moist wound healing can produce huge results for you and your patients.

Moist wound healing is a method of treatment in which the wound is kept in an optimally moist environment to promote cell growth and the formation of new skin tissue. While scabbed wounds generally do heal with time, keeping a wound moist can accelerate this process by nearly 50%. Not only that, but the resulting skin from moist wound healing can have a better cosmetic outcome, as the aqueous medium allows collagen fibres to align themselves more freely.

The role of exudate

The reason moist wound healing can be so effective is because the technique maintains an optimal level of exudate in contact with the wound at all times. Exudate is the moisture that naturally seeps out of a wound site, which serves not only as a vehicle for growth factors, hormones, and essential nutrients, but also as a medium for white blood cells to fight off infection and destroy invading foreign bodies. By keeping the right level of moisture, wounds can benefit from continuous 24-hour a day healing, improved cell growth, and even reduced pain, as the nerve endings on the skin are kept hydrated and bandages do not adhere when they are changed.

When dealing with exudate, it is vital to maintain a consistent amount to help autolytic debridement and optimize recovery time. Too little exudate and the wound will dry out. Too much and the surrounding skin can macerate, slowing down healing. That is why it is highly recommended to use a semipermeable foam dressing (see Figure 1) when there is a significant amount of exudate present. This type of dressing absorbs excess exudate, allowing moisture to evaporate out the back without drying out the wound. However, once a wound begins to produce less exudate, it is important to evaluate the wound to see if there is any further risk of infection. If there is, more honey dressings should be applied. If the risk is low, it is generally safe to switch to hydrogel. In either case, a foam dressing on a non-exudating wound can dry it out, so it is necessary to supplement the natural moisture with either honey or hydrogel (or both) to prevent the dressing from adhering.

Figure 1. The benefits of using semipermeable foam dressing.

Keeping the wound clean and moist

One of the most important factors in a comfortable and efficient healing process is keeping the wound clean and sufficiently moist, and a very effective natural solution for this is honey. First used in wound healing in 1500 BC by the Ancient Egyptians and Greeks, honey has several unique characteristics that make it ideal for staving off infection. The pH of honey creates the desired acidic environment to decrease bacterial growth, while also increasing fibroblast activity and the release of oxygen. Honey is also highly osmotic, meaning it draws fluid and lymph from underlying tissues, thus providing nourishment for the healing wound. Further, the Glucose Oxidase in honey converts to Hydrogen Peroxide and gluconic acid while in contact with the exudate from the wound. At low levels, this hydrogen peroxide offers antibacterial benefits, while also promoting angiogenesis and fibroblast activity.

The benefits of moist wound healing.

Of the varieties of honey available around the world, New Zealand’s “Manuka” honey is one of the most well known for its excellent anti-microbial action. In addition to the regular wound healing benefits of honey, Manuka honey actually continues to produce Hydrogen Peroxide for much longer than other varieties. This is because regular honey naturally breaks down faster and is also often pasteurized, wherein the heat largely diminishes the Glucose Oxidase effect. 100% Medical Grade Manuka Honey is Gamma sterilized to keep the Glucose Oxidase active as long as possible. In addition, Manuka honey is also the only type of honey to contain MGO Methylgluoxal, which itself has powerful anti-bacterial properties. Even once the Hydrogen Peroxide is gone, the MGO continues to protect and heal the wound.

Choosing your moist wound healing approach

As in most cases in veterinary medicine, your approach to employing a moist wound healing technique is highly dependent on the case. A wound that is exudating heavily may require a highly absorbent dressing to remove some moisture and prevent maceration of the surrounding skin, whereas a wound displaying healthy granulation without much exudate may benefit more from a non-adherent dressing impregnated with honey or hydrogel. To know when to switch from the antibacterial honey to the moisturizing hydrogel, here’s a helpful rule of thumb: for yellow wounds use yellow honey, for clean wounds use clear hydrogel!

To aid you in making the best choices for your animal patients, learn more about moist wound healing at kruuse.com. You may also want to refer to Maximizing Wound Management by Derek Knottenbelt, a well-renowned veterinary professor in wound management, which presents a flowchart for approaching different types of wounds and details the twelve main identifiable inhibiting factors that affect wounds.

Using ozone for disinfecting PPE

Being able to safely clean our valuable Personal Protective Equipment (PPE) so it can be reused is vital any time, but especially during the COVID-19 pandemic. Here’s how medical ozone does the job.

This is a transcript of Dr. Margo Roman’s instructional video for first responders and other medical workers on how to safely clean Personal Protective Equipment (PPE) using ozone, so the equipment can be reused.

“Hello, I’m Dr. Margo Roman, and I want to tell you about a simple technology, easily accessed, that can help protect our frontline healthcare workers and first responders in this COVID-19 pandemic.

“Medical ozone is a treatment modality that has been around globally, used by doctors and dentists, for over 30 years. Not only can it be used to combat infection and chronic disease in humans, but I have [also] used medical ozone in my veterinary practice since 2003. Our team has [performed] over 70,000 treatments in that time, and we are using it for all types of medical conditions, including severe viral and bacterial infections as well as for sterilizing our own Personal Protective Equipment, our masks and our gowns.

“Medical ozone means utilizing the power of oxygen radicals to disrupt biological organisms like bacteria and viruses. Oxidizing is the primary way our bodies break down toxins and invaders. The oxygen we breathe, the O2, is very stable and safe. Oxygen is needed for our survival. Ozone molecules have an extra oxygen atom which makes them very unstable. They can quickly break down into stable O2, an active oxygen molecule. We can create ozone molecules by using electricity to stimulate pure surgical oxygen. This is done in a simple apparatus called an ozone generator. The ozone gas created in the generator can now be used in medical applications.

“In this video, I will demonstrate the simple procedures of using ozone gas to help sterilize our PPE. The protective gear [that] medical staff need is in short supply. Gowns, masks, helmets, and gloves can be all sterilized quickly by bathing them in a high concentration of ozone. For most of these procedures, we use gaseous ozone at a concentration of 75 micrograms per milliliter. The concentration of ozone is a product of setting your generator and your speed of airflow. The slower the oxygen flow, the more concentrated the ozone.  For this reason, we typically use a pediatric regulator on the oxygen tank so we can get the flows as low as 1/32 liter per minute. The ozone gas created in the generator can now be used in medical applications, [such as] disinfecting water and Personal Protective Equipment, and even treating infectious disease directly. The key to successful disinfection is not mixing up the contaminated and clean gear equipment. I recommend that you wear gloves and wash and disinfect the gloves after handling the contaminated PPE.

“The simplest ozone system is a tank of medical oxygen, a pediatric regulator valve, a tube between the oxygen source and the generator, and an outflow tube from the generator carrying ozone. It is important that the ozone carrying tube be made of silicon because a standard plastic or rubber tube will degrade from contact with the ozone. Line a bin with a plastic garbage bag, making sure you have a generous cuff around the outside. This will enable you to not touch the contaminated [interior] of the bag when you close it up later. Load all your gowns, helmets, and visors into the bags. The smaller PPE, such as personal masks, can be put in a smaller bag and marked with the owner’s name. We recommend disinfecting your gear with at least 70 micrograms per milliliter of ozone. On this unit we need a flow of 1/8 liter of oxygen per minute to get that strength.

“Wash and disinfect your hands after loading your PPE and before handling your ozone generator and oxygen tank. When you are ready to begin, open the valve on your oxygen tank, set your regulator to the desired flow rate, in this case 1/8 of a liter per minute. Be sure you have good ventilation in the room [where] you are working and don’t breathe the ozone gas directly. Insert the ozone tube into your personal PPE bag, flatten out the excess room air and zip the bag closely around the tube. Now turn the ozone generator on and you are making an ozone/oxygen mixture.

“When there is visible air in your bag, remove the ozone tube, seal the bag, and place it into a larger gear bag. In this way, both the inside and outside of your personal gear bag will be disinfected. Remove the larger gear bag from the bin, handling only the outside of the bag. Insert your ozone tube into the end of the bag. Use a zip tie to hold your ozone tube tightly within the bag so no ozone will escape while filling. Once there is a visible fill in the bag, carefully remove the tube and reseal your bag, fluffing the contents so that the surfaces are in contact with the ozone, and set aside. Since the outside of your ozone tube may be contaminated from contact with the inside of the bag, disinfect it right away with alcohol or disinfectant wipes.

“Leave the bag for one hour. It’s best to open bags outdoors or in an area with an effective outflow fan. Ozone in this state should not be breathed directly as it’s irritating to the lungs. Once your bag is opened, fluff it several times to disperse the remaining gas. Now your gear is clean and ready for reuse.

“Medical ozone is a powerful virucide that can protect first responders and

health care providers as well as dramatically improve patient outcomes during this pandemic and beyond. On the screen are links to multiple ozone societies, groups of doctors using oxidative therapies in their clinics every day. There are also links to companies that make, distribute, and sell ozone generating equipment. These innovative technologies can be scaled up to decontaminate PPE on a major scale, whether using O3 or H2O2 as the oxidative source. Ozone can also be used to revolutionize food safety with ozonated water to decontaminate supermarket produce.

The value of medical oxidative therapies has been scientifically proven. Now it is time to make it a critical part of COVID-19 prevention and treatment. Please contact me, Dr. Margo Roman, to connect with resources and answer your questions. Thank you.”

Video credits

Script & Storyboard: Karen Gellman DVM, PhD, equinesportsmed@mac.com

Illustrations & Photography: Michael A. Simmons MFA, medbioart@mac.com

Editing & Graphics: Alec Simmons, alec.r.simmons@gmail.com

Links to US and international medical oxidative therapy groups

https://ozonewithoutborders.ngo

https://aaot.us/default.aspx

https://www.ozonetherapiesgroup.com

https://sopmed.org

Links to ozone equipment resources

https://www.o3vets.com

https://www.simplyo3.com

https://www.promolife.com

https://drosolutions.com

Aging problems in cats: helping clients through the golden years

Offer your clients the guidance they need to enhance their feline companion’s quality of life and longevity throughout the aging process.

As animals grow older, their ability to function can decline – sometimes significantly. Pet parents are understandably concerned, hoping to keep their aging cats comfortable and as healthy as possible. As veterinarians, we can make life easier by offering practical take-home advice.

Let them know that a certain level of decline is normal

A little bit of reassurance can go a long way toward giving clients peace of mind. Help them understand that cats can suffer from age-related feline cognitive dysfunction (FCD) that can contribute to a variety of issues including:

  • Anxiety
  • Aggressive reactions
  • Changed social behavior with the pet parents and other pets in the home
  • Altered sleeping patterns
  • Forgetting where food is or eating less
  • Grooming less
  • Forgetting where the litter box is located
  • Eliminating near eating areas or sleeping areas
  • Seeming lost in familiar locations or wandering aimlessly
  • Seeming uninterested in interactions or suddenly seeming clingy and overdependent

If cognitive dysfunction is present, you can explain that medication might be able to help. Selegiline hydrochloride (Anipryl®) is used to treat cognitive dysfunction in dogs, but there is anecdotal evidence from vets and behaviorists concerning its ability to improve functioning in cats with FCD. Nicergoline (Fitergol ®) and propentofylline (Vivitonin ®) might be appropriate choices as well.

Editor’s note: Propentofylline and Nicergoline are not licensed/available for use in the US.

Encourage clients to keep aging pets comfortable at home

Even when cognitive functioning seems normal, vision changes, hearing changes, and mobility challenges call for special accommodations. Geriatric cats might appreciate:

  • Night lights in important areas such as near the litter box, food, and frequently-traveled routes throughout the house
  • Area rugs or yoga mats placed on slippery sections of floor
  • Stick-on scent markers such as Tracerz® can help blind cats find their way around
  • Warming beds to comfort aging, achy joints
  • Litter boxes with low sides for easier access
  • Additional litter boxes placed where they are easy to find and access
  • Pheromone therapy to help with anxiety
  • Anti-anxiety medications to ease worries and help reduce the loud, repetitive vocalizations that can accompany cognitive and physical decline
  • Ramps to access favorite resting spots such as the sofa or a window seat

Encourage proper nutrition

Some pet parents might not realize that the right food can help cats stay healthy and comfortable as they age, so be sure to mention therapeutic diets if they are warranted. Mention the increased importance of hydration for stable kidney functioning and recommend switching to wet food from dry when cats might not be drinking quite enough.

In addition, you can explain that supplementing with glucosamine and chondroitin can help improve joint comfort, particularly if these supplements are added before time takes too much of a physical toll on the cat’s body.

Stress the importance of regular visits

Pet parents can help their cats stay comfortable and healthy by taking them for more frequent checkups – every six months or so instead of just once a year. Regular bloodwork, urine testing and physical examinations often catch problems in their early stages when they’re easier to control and less costly to treat. Finding and correcting problems early means less stress for cats and their human companions alike, as well as improving quality and length of cats’ lives.

Conclusion

With compassionate guidance from veterinarians, pet parents can face aging issues from a well-informed place. Knowing what to expect and how to approach problems empowers clients and makes it easier for them to give geriatric cats a better quality of life.

How veterinary rehabilitation can benefit obese dogs

Canine obesity can lead to a range of diseases. Veterinary rehabilitation practices with weight loss programs will help overweight patients shed excess pounds, thereby improving their overall health and longevity.

Canine obesity is not just one disease – it represents a major risk factor for a plethora of serious yet preventable health problems. That fat, adorable, jiggly Labrador in your exam room is at risk for developing diabetes mellitus, urinary incontinence, osteoarthritis, and pulmonary diseases, as well as many other life-threatening conditions,1 and is also at risk for a shortened life span.2 Veterinary rehabilitation practices offer you the opportunity to recommend safe and successful weight loss programs that will assist clients with obese dogs. Each patient will most likely present with a significant number of comorbidities (such as marked osteoarthritis) that must be carefully managed to ensure his safety. Trained veterinary rehabilitation therapists are perfectly positioned to help these dogs.

Start with an in-depth client interview

Studies have indicated that 34% to 59% of dogs are obese or overweight.1,3,4,5 In order to tackle this heavy problem (no pun intended), a number of investigations must begin.  An in-depth interview surrounding the dog’s lifestyle should be conducted, including but not limited to:

  • Daily routine: A rundown of a typical day for the client’s dog.
  • Current activity level: This includes walks, runs, play, etc.
  • Quality of life: How does the client feel the dog is dealing with his weight?
  • Complete calorie count, including treats and table scraps: Don’t forget to ask how the client is measuring the dog’s food – do they use a common cup or a standard measuring cup?

  • Previous medical history, including recent bloodwork: It is absolutely essential to rule out any underlying metabolic conditions that will dampen weight loss efforts, such as hypothyroidism or hyperadrenocorticism.1

Set mutual and obtainable goals with the client

It is also necessary to establish realistic expectations with the client. Every client’s lifestyle is unique, and weekly rehabilitation or underwater treadmill visits may not be reasonable or realistic to him or her. The client may not agree that the dog’s weight represents a major issue or hindrance to overall well-being. For these hesitant clients, the author provides research studies2 while also highlighting the fact that physically fit dogs, just like humans, are likely to live longer than overweight ones. It may be necessary to discuss the high probability of chronic diseases, such as diabetes and arthritis, and their associated financial costs. By setting mutually agreed-upon and obtainable goals, you will find clients are more compliant and honest, leading to more successful outcomes for weight loss programs.

Weight loss program basics in veterinary rehabilitation practice

1. Controlling the calories: food intake 

Counting all the calories coming into the dog before initiating the weight loss program will make it easier to control the calories coming in after the program starts. As a trained veterinary canine rehabilitation therapist, this author prefers to have clients complete a “daily food diary” of everything and anything that enters the dog’s mouth. In more cases than not, one family member is the predominant “treat-giver” (or “calorie-provider”).  Explaining to clients how to read the kilocalorie count on a treat or food bag will help them realize just how many kilocalories they are feeding their furry kids every day. It is strongly recommended that this food diary be kept up throughout the weight loss program in order to keep clients accountable for their dogs’ daily food intake.

Once clients understand the number of kilocalories their dogs should be consuming, it is then a matter of adjusting their daily kilocalorie intake. The veterinary market offers numerous weight loss diets that target satiety with increased fiber content. Alternatively, you may find that simply cutting out all high-calorie (and heavily-laden fat content) treats is a far more effective method.

2. Safely increasing activity levels

Just as in human medicine, increased activity levels can help burn fat and preserve joint function. For obese dogs, however, a veterinary rehabilitation weight loss program tailors the program to each patient’s current ability. Overweight or obese dogs are at increased risk for musculoskeletal injuries; concurrent diseases, such as tracheal collapse or painful osteoarthritis, can affect the safety of prolonged exercise. Land-based exercises, joint manipulation, land dog treadmills, acupuncture, and hydrotherapy (underwater treadmill therapy — UWTM) can be utilized to provide a safe, pain-free weight loss plan for any obese or overweight dog.

  • Land-based exercises consist of personalized exercises targeting core muscle groups, as well as exercises to increase endurance without placing excessive pressure on the joints. A major benefit of land-based exercises is that they can be taught to the client and continued in the home setting for the rest of the dog’s life. Once your patient has lost the excess weight, the next step is to maintain that lower weight! Veterinary rehabilitation therapists are trained in these exact areas.
  • Underwater treadmill therapy safely increases the obese/overweight patient’s endurance level via a reduced weight-bearing and buoyant environment. The warm water environment can aid in muscle relaxation and facilitate the motivation to walk. Turbulence and depth can all be controlled for a more individualized workout. Weaker patients will reap more benefits from the safety and control of an underwater treadmill than in open swimming pools. Research has demonstrated that raising the water level to hip height reduces the total body weight to about 38% .6 Swimming pools also offer these benefits, but in a more uncontrolled setting.

3. Managing pain in patients with concurrent osteoarthritis

For obese dogs that also have advanced osteoarthritis, veterinary rehabilitation therapists offer non-invasive pain management techniques, including veterinary acupuncture and veterinary therapeutic laser therapy. These methods can be incorporated easily into any weight loss program. See Table 1 below for an example of a weight loss program within a veterinary rehabilitation practice.

Analyzing weight loss success

Weight loss success can be measured in a number of ways; most often, of course, the measurement of true success is seeing numbers decrease on the electronic scale. While your clients may wish to quantify success this way, the author believes that a number of other factors should also be included when analyzing the success of a weight loss program. Every week, the following should be gauged:

  • Stance
  • Energy levels
  • Stamina
  • Quality of life
  • Decrease or elimination of comorbidity signs (such as coughing from tracheal collapse or limping from arthritis)

Stance analysis can include weekly or bi-weekly standing photographs – body changes may appear very small from week to week, but an initial photograph or “before” video versus the end photograph or “after” video can speak volumes!

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1German AJ. “Concurrent Symposia 2: Pet nutrition and chronic disease; outcomes of weight management in obese pet dogs: what can we do better?” Proceedings of the Nutrition Society. 2016 Aug; 75(3):398-404. 

2Kealy RD, Lawler DF, Ballam JM, et al. “Effects of diet restriction on life span and age-related changes in dogs”.  J Am Vet Med Assoc. 2002 May 1; 220(9): 1315-20.

3McGreevy PD, Thomson PC, Pride C et al. “Prevalence of obesity in dogs examined by Australian veterinary practices and risk factors involved”. Vet Rec. 2005 May 28;156(22):695-702.

4Lund EM, Armstrong PJ, Kirk CA, et al. “Prevalence and risk factors for obesity in adult dogs from private US veterinary practices”. Int J Appl Res Vet Med. 2006;4(2):177-186.

5Colliard L, Ancel J, Benet JJ, et al. “Risk factors for obesity in dogs in France”. J Nutr. 2006 July;136:1951S – 1954S. 

6Owen, MR. “Rehabilitation Therapies for musculoskeletal and spinal disease in small animal practice”. The European Journal: companion animal practice. 2006;16 (2):137-148.

Prioritize quality and comfort when choosing a urinary catheter

From short-term flushing to long-term post-surgery drainage, here’s how to choose a catheter that will maximize comfort and minimize trauma.

Most people simply know urinary catheters as tiny tubes designed to empty patients’ bladders, but not everyone is aware of the distinctions and different uses that make certain types of specialized catheters more suitable at times than others. As a vet, one of the most important distinctions you can make in choosing a urinary catheter is in determining the length of time that the device will have to be inside the patient. This can dictate everything from the ideal material, to the ease of insertion, to the device’s design, all of which can come together to greatly enhance your patient’s comfort. It is important for you to gauge your case, to see what solution will work best.

Instant-term cases

Instant-term cases are classified as those where the catheter is only needed for 10 minutes or less, usually for things like urine sample collection, bladder tension relief, or for bladder lavage (flushing the bladder with sterile saline). In these situations, extended biocompatibility is not as important as comfort and ease of introduction, as the catheter will not be present in the body for long periods of time. Because these are quick procedures, it can be particularly time-saving and smooth to employ a catheter with a hydrophilic coating. While not designed for long-term use, HC urinary catheters can be activated by water and easily inserted without the need for additional lubricants.

Short-term cases

Short-term cases are those where the catheter is intended to remain in place for no more than one day. Because they are not in situ (in position inside the animal) for very long, there is some allowance for rigidness and a lesser degree of biocompatibility. For instance, because they are inexpensive and easy to insert, many practices still use polypropylene catheters for short-term cases. These can be rigid and uncomfortable, and while they still work as long as they are not left in situ for longer than a few hours, there are better options. A specialized PFTE catheter, for example, is rigid when introduced but softens from the body temperature, making for easier insertion and enhanced comfort. For flushing make sure to chose a catheter with an open end.

Mid-term cases

Mid-term cases are those where the catheter can remain in situ for 2–3 days. This is commonly seen in patients with a condition like Feline Lower Urinary Tract Disease (FLUTD), which can be caused by urolithiasis (urinary stones), urinary infection, or a urethral obstruction. These patients need a secure urine passage, and may also require a way for the vet to flush uroliths retrograde into the bladder in the case of an obstruction.

Because the catheter must stay in the patient for several days, rigid catheter materials like polypropylene should not be used. Instead, soft and comfortable materials like PVC,  polyethylene or PTFE are preferred. For mid term patients make sure to choose a catheter with side holes, to reduce the chance of occlusion and with a LL connector, so you can easily connect the device to a urine collection bag.

Long-term cases

Long-term catherization cases, which are often necessary during hospitalization and post-surgery recovery periods, refer to situations where the catheter is in situ for 3–7 days. In these cases, comfort and biocompatibility is extremely important to minimize patient trauma and prevent pain or secondary infections. Softer materials such as polyurethane and silicone are highly encouraged, and this is also the time frame where an indwelling Foley catheter could be considered. A Foley indwelling catheter is a device that has a small balloon on the inserted end, which will be inflated and keep the catheter in place for longer periods of time. Foley catheter are only made for Dogs. If the material is well chosen, this can be a less disruptive solution for a long-term patient. Cat Catheters are more likely to slip out due to the anatomy of the urinary tract, so it´s important to choose a catheter which has a suturing disc so it can be fastened to prepuce.

Choosing what works for the patient

As with nearly all areas of veterinary medicine, it is important to take a critical lens to your patient’s situation in order to determine the best possible solutions. For patients with difficulty emptying their bladder, urinary incontinence, or urinary retention, the length of time that the catheter is in place is only one dimension of finding the perfect fit – but it is crucial nonetheless. By approaching each case with a focus on maximizing the comfort for your patient, and by taking into account the animal’s history, temperament, and how long he will be hospitalized, it is possible to minimize the amount of trauma inflicted in an already stressful experience.

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Advice vets should give to pet parents experiencing loss

Supporting your clients through the loss of their pets is one of the most important roles you’ll have to fill as a veterinarian. Here’s some advice you can offer to help make the experience less painful.

Research proves the strength of the human-animal bond – and additional research shows that many pet parents feel the death of a companion animal just as strongly as they feel the loss of a human friend or loved one. How should veterinarians support their clients, then, as they grieve the passing of their animal companions? While every situation is unique, the following advice is often helpful.

1. If euthanizing a pet, prepare your clients for the experience

We as veterinarians know that euthanasia is the final kindness. At the same time, it is never easy for pet parents to say goodbye. We can ease the process by providing information about preparing for euthanasia, helping clients understand what’s happening during the procedure, and offering options for taking care of the pet’s body afterward.

There are numerous websites with information that can help everyone on your care team provide pet parents with the support they need during difficult transitions.

Similarly, if a client comes to you wanting to terminate their dog’s pregnancy, remember that they still may go through the same feelings of guilt and grief. The dog is also very likely to experience a period of mourning, so it’s a good idea to provide information on how to prevent pregnancy in the future, and give advice on how they can best care for their dog and themselves during this time.

2. Encourage pet parents to allow time and space for grieving

Let your clients know that it’s normal to experience a wide range of emotions as they process their loss. People often feel anger, shock, disbelief, and numbness. Many find themselves feeling a sense of relief that their companion’s suffering has come to an end. Guilt, sadness, regret, and anxiety are part of the spectrum, too.

Losing a pet leads to big changes in a person’s daily life. There are moments when that loss might be felt with great intensity, and at those times, it is important to acknowledge and release those emotions. Your clinic may wish to provide information about the stages of grief and encourage people to seek counselling as a way to fully process their emotions.

3. Encourage clients to memorialize their pets

Even though death is permanent, memories live on. Reflecting on those happy, carefree times can help pet parents work their way through grief and experience a sense of gratitude for the wonderful bond they shared. Encourage clients to remember the sweet moments, the fun times, and the silly antics that made their pets unique. Remembering good times balances the pain of grief.

Pet memorial sites, special headstones, and even pet memorial jewelry offer different methods for memorializing pets while reminding your clients of the special ways their animal companions enriched their lives.

Saying goodbye is an important part of closure and pet parents might find it helpful to write letters to their pets, particularly if the loss was sudden and unexpected. Writing is a tangible way to express grief and it’s an excellent way to create a tribute to a pet – even if no one ever reads what has been written.

4. Emphasize the importance of self-care

The pain of grief can bring life skidding to a sudden halt. During the first few days following the loss of a pet – and sometimes for a longer period than that – your clients may find themselves sleepless, suffering from a low appetite, and even isolating themselves from others.

Encourage pet parents to make self-care a priority. Remind them to eat nourishing foods and urge them to connect with others who care. Other self-care practices including warm baths, meditation, walking, or simply watching favorite TV programs can be very helpful. The same principal goes for pets who may be mourning a brother or sister, or may have gone through a termination pregnancy.

Some employers might feel empathetic and allow a little time off work after the loss of a pet. In case time off isn’t granted, veterinarians might encourage their clients to spend the next few weekends focusing on enjoyable activities.

5. Offer tips on caring for other family members

If your client has other pets and family members, encourage them to take special care of them in the period following their loss. Family members, friends, and living pets are an important part of a pet parent’s support system – and in many cases, they’ll feel the loss of the pet, too. Cats are likely to isolate themselves when they’re missing a friend; dogs actively search for other pets after a loss; and children experience intense grief when a pet dies.

Veterinarians can help by providing resources for helping other pets during this transition. It may be helpful to provide families with tips for explaining a pet’s death to children as well. Maintaining structure and going through the motions of familiar rituals can ease the pain and help families find a sense of normalcy over time.

6. Remind people that there’s no hurry to get a new pet after a loss

It’s a question many vets hear often: “When should I get a new pet?” There’s no need to be in a hurry. Pet parents need to allow themselves time to grieve fully, and to view a new pet as a unique individual. After all, there’s no replacement for a pet, just as there’s no replacement for another person. The time is right when a pet parent can remember their original companion animal with a sense of gratitude and fondness, and when there’s a sense of eagerness toward building a new relationship with another pet.

If a pet is aging and your clients are mentally preparing themselves for the loss, they may ask for an opinion concerning when to get a new pet. Many families do find it helpful to adopt a new pet before an older one passes away; it sometimes helps ease the transition and allows your new pet to become part of the family before that final “goodbye”. At the same time, another pet may provide comfort and support during the older pet’s transition.

It’s never easy to cope with a pet’s passing, but with help from compassionate veterinarians, grief counselors, and pet loss support groups, people may find the transition a little simpler.

Scrutinize product claims when choosing supplements to sell or recommend

Product claims on packaging can be very misleading. Be sure to do your research before recommending a health or nutritional supplement to your clients.

When reviewing health and nutritional supplements to carry in your practice or recommend to clients, it’s very important to pay close attention to product claims on packaging and marketing materials. Marketers know you’re busy, and that they have very little time to capture your attention and convince you to take a closer look. The language they use can make all the difference. Unfortunately, some brands take a “say anything” approach to selling that misleads buyers and casts a negative shadow on the entire supplement industry.

The U.S. Food & Drug Administration’s Center for Veterinary Medicine regulates animal health and nutritional supplements, and follows the law established in the Federal Food Drug & Cosmetic Act regarding product claims, in order to protect consumers and animals. The good news is the majority of pet supplement suppliers understand and follow these rules and are careful to make credible claims allowable by law. Many of these suppliers are members of the National Animal Supplement Council and have access to succinct labeling guidance to help them follow the law and avoid making errant or egregious claims.

Keep a careful eye out for suppliers that disregard the rules for product claims. They are fairly easy to spot when you know what to look for:

  • Words that state or imply the product will treat, prevent, cure or mitigate a disease. Example: “Aids against UTIs and bladder infections”.
  • Use of any disease name or reference to a disease. Example: “Fights gingivitis and periodontal disease”.
  • Any stated or implied comparison to, or replacement for, pharmaceuticals. Example: “Reduces the need for prescription pain medication”.
  • Any reference to a chronic Example: “Protects against chronic pain and inflammation”.
  • Claims disguised as product names. Example: “Inflamm-Relief”.

Keep in mind that product and brand marketing are an extension of the label, and are therefore subject to the same rules. Apply the same cautious scrutiny when visiting a company website as you would when looking at the product package. This also applies to internet advertising, trade show materials, social media posts, blogs, e-newsletters and YouTube channels, as well as more traditional advertising like radio, TV and print ads.

Allowable or “good” claims on supplements are typically simple and concise. They communicate that the product helps support the normal structure and function of a dog or cat’s body rather than trying to correct an abnormal condition or disease. And perhaps most importantly, allowable claims don’t rely on absolutes or language that over-promises outcomes. Allowable product claims include:

  • “Contains ingredients to support a healthy urinary tract”
  • Promotes normal periodontal health”
  • Maintains healthy liver function”
  • Supports a healthy inflammatory response”.

Supplements are not a magic bullet. If a claim sounds too good to be true, it probably is. Selecting products with the NASC Quality Seal will help ensure you are dealing with suppliers that responsibly produce and market their products within the bounds of the law, rather than preying on consumer vulnerabilities in the name of profit.

Why some mushroom-based supplements are more effective than others

Mushroom-based supplements are a natural remedy for a range of metabolic, physiological and immunological ailments in animals. The key is to understand what makes these products effective – and which ones to avoid.

In today’s modern veterinary practice, more and more clients are looking for safe, natural solutions to improve the health and nutrition of their furry companions. In response, many leading veterinarians are turning toward the world of fungi for answers. Backed by a number of scientific studies, medicinal mushrooms are emerging as one of the most promising natural compounds to enter the field of pet nutrition. Demonstrating encouraging results in modulating the immune system, reducing inflammation, lowering cholesterol, and even helping to prevent certain cancers, mushroom-based nutritional supplements are a great addition to any vet’s toolkit.

What makes medicinal mushrooms effective?

Mushrooms, or rather the beta-glucans found in mushrooms, can offer a host of health benefits for both pets and humans. Beta-glucans are sugars found in the cell walls of fungi. They are also the key active compounds that help certain medicinal mushrooms produce powerful anti-inflammatory and immune system modulating effects.

In order to gain these benefits, however, it is important that your patients be given regular, reliable doses. Despite the noted benefits of prescribing mushroom-based supplements as part of a companion animal’s nutrition plan, not all brands or types of these supplements have been shown to confer the full potential advantages every time.

Not all mushroom-based supplements are created equal

While using all the parts of the fungi might logically seem like an effective way to reap the most benefits, this is not generally the case. Certain parts of the fungi, such as the mushroom (fruiting body), contain significantly more beta-glucans and other beneficial compounds than others. This discrepancy is widest when the mushroom is compared to the mycelium.

The mycelium is the branching, vegetative part of the fungus. It consists of a mass of filamentous hyphae, which are the fungi’s main method of absorbing nutrients in the early stages of growth. This allows the fungi to produce fruiting bodies, such as the coveted mushrooms.

Though the mycelium is essential in the growth of the mushroom, it is not nutritionally beneficial in itself. Not only does the mycelium contain fewer beta-glucans, but it also absorbs and stores compounds from the solid substrate it was grown on.  Because most commercial mycelium producers use the “Mycelium On Grain” (MOG) method, growing their mycelium on rice or oats, grains often become an inseparable part of the final product, leading to high amounts of starch. When included in a supplement alongside the fruiting body, the mycelium often acts as nothing but a high-starch filler.

Maximizing your mushroom supplements

If you’re prescribing mushroom-based supplements, you’ll want to know for certain what proportion of mycelium to mushroom is included in the dosage, and what method was used to produce the mycelium. The unfortunate reality is that many commercially available mushroom-based supplements are made with an unequal mixture of highly-beneficial mushrooms and less-beneficial mycelia. This can lead to dosing inaccuracies and ultimately reduce the benefits of the supplement.

The development and study of fungi in the pet nutrition industry is an exciting advancement, and the results are speaking for themselves already. However, before you incorporate mushroom supplements into your own practice, it is important to do your research into the composition of each product. Your patients will thank you!

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